U.S. Agency for International Development (USAID) Mission Directors Meeting

I want to thank Andrew Natsios and Anne Peterson for inviting me to join you this morning. I know it isn’t often that all of you meet in one place so this was an opportunity I couldn’t pass up. As you may know I was confirmed by the Senate last Friday and sworn in on Monday, which means that this is the first official address in my capacity as Global AIDS Coordinator.

It is a pleasure to deliver it here this morning, and I hope I will have an opportunity to meet with many of you in your countries of assignment over the course of the coming years. I want to use this time to say a few words about the President's Emergency Plan for AIDS Relief. But what I really want to do is use this opportunity to tell you who I am and to describe the kind of relationship I expect to have with you and with the Washington-based leadership of USAID. Finally I will offer a few thoughts on the long term ramifications of this initiative. And then I look forward to taking your questions when I finish.

As you probably already know, the President of the of the United States, in his State of the Union Message last January announced his Emergency Plan for AIDS Relief, setting ambitious targets. By 2008, two million persons on treatment, another 10 million in care including orphans and vulnerable children and 7 million new infections prevented. The President pledged a tripling of current USG investment over 5 years, to fight the international epidemic -- from $5 billion to $15 billion. And unlike some initiatives, some mandates that have landed on your plates, this one will have newly appropriated funds.

Much attention has been appropriately directed to the core of the President’s Emergency Plan which focuses on 14 countries in Africa and the Caribbean that are among the most severely affected by the AIDS pandemic. These countries alone account for 50% of the AIDS infections in the world, and they will be the primary focus of my initial attention.

But as the Global AIDS Coordinator, the President has also charged me with ensuring our continued efforts to stem the spread of AIDS in other countries, including through strengthening our existing activities in some 75 nations around the world where today we have bilateral HIV/AIDS programs. In addition to our new and existing bilateral efforts, the Global Fund will continue to play a vital role in our overall efforts, and I also look forward to accepting my responsibilities for providing coordination and leadership to the Global Fund activities of the United States Government.

Last spring, Congress passed and the President signed the “United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003”. This act further defines the Initiative’s goals and creates the position I now hold. Some of the provisions of the Act will require further clarification, some of which will come with the final appropriation bills and some of which will come from consultations with the White House and leaders on Capital Hill. But one things stands clear: the President of the United States has personally charged me with achieving his goals -- and I mean personally.

To this end I have been given by act of Congress and the signature of the President, broad authority to implement programs, and I bear the responsibility to coordinate all international HIV/AIDS programs for the U.S. Government and to provide oversight for this effort.

Which brings me the main topic I want to raise this morning: How I will translate mandate, authority, and responsibility into a productive working relationship with USAID, HHS, DOD, NGO’s and others who must be partners in all of this if it is to work? Let me start my answer to that question by telling you a bit about myself, because therein perhaps lies much of the answer.

I spent nearly four decades in the corporate world, where I had the privilege of serving in a number of challenging roles -- as CEO of AT&T International, as chairman of the board of trustees of Duke University, and as CEO of Eli Lilly and Company -- organizations and institutions that have made significant contributions to making the world a better place. The global reach and impact of the products and services of both AT&T and Lilly have helped to transform the lives of hundreds of millions of people, here in the United States and around the world.

In 1999, I stepped down from all of that with a great sense of satisfaction. I was proud of what had been achieved, but I was looking forward to turning my attention to some other things I though were important in life. In announcing that decision, I quoted Peter Lynch, a well known money manager who also retired somewhat earlier than expected, and in so doing, was quoted as having said, “No one on his death bed ever said, ‘Gee, I wish I’d spent more time at the office!’” I had a different plan for this phase of my life right now.

In February of this year, the call from the White House to gauge my willingness to talk about this assignment was completely unsolicited and totally unexpected. But as I’ve come to understand what the President has in mind, and knowing the magnitude of what is at stake, it has become quite clear to me that the relevance of all of those prior assignments pales in comparison to the challenge and the importance of fighting the global scourge of AIDS. I'm extremely grateful that President Bush has offered me the chance to contribute to this effort. I can think of no higher calling than to be addressing these issues on behalf of my country -- to bring to bear the experiences I’ve had and the lessons I’ve learned about how to get things done.

I am not a scientist, or a doctor, or a public health expert. But I believe I bring to the task at hand attributes essential to meeting a challenge of this magnitude. Those are passion for the goals, vision, a set of global experiences, management and leadership skills and a strong motivation to make a difference. If there is any one thing that characterizes my leadership experience, it is managing change.

And in learning to do that successfully, I’ve learned that you have to draw a distinction between having formal mandates and authorities, and being effective as a leader and a manager. The former are necessary, but without the latter you’re not likely to accomplish as much.

I understand well that the United States Agency for International Development has been at the forefront of international assistance since 1961. You have gone to some of the toughest and most dangerous places in the world and you have transformed health, agriculture, education, trade, and in some cases even democracy itself. USAID has been at the front lines of the international response to AIDS since 1986, and you now have HIV/AIDS programs in some 55 countries.

You’ve founded national family planning programs with a global infrastructure for distribution of contraceptive commodities. You’ve pioneered new technologies like rapid HIV tests and safe injection equipment and then put them to use in the field. I could go on but in short, you have improved the lives of countless millions of people.

Why, you may ask, am I telling you things you already know? It’s simple. Seeing what you are capable of I am now asking you to do it again; this time in response to a global epidemic unprecedented since the Black Plague. But I’m also asking you to embrace change with me. Just because “it’s the way we do it,” or “it’s the way we’ve always done it” are not reasons I’m going to be excited about. If it’s the best way we can together figure out to save lives and employ our resources effectively, then it will have my full support. USAID is a critical element of the nation’s response to this crisis and without your full partnership, I see no way to meet the challenge given to us by President of the United States.

Now I know a few other things about you. I know you are implementing at last count 16 other Presidential initiatives. I know that you work under budget constraints, and personnel constraints; and you work in places where the security and political environment seriously limit the extent to which you can operate. And so starting today we need to begin a conversation that asks the question “how are we, working together, going to get where we need to go?” As I see it we need to talk about three things: What works? What needs to be fixed? and What are my expectations of USAID?

First and foremost we need to talk about what works and what doesn’t. Often when you approach an expert with a new idea, the response you get is “that won’t work.” Reality always gets in the way of plans that made so much sense when we talked about them in Washington. But what I need to hear from you is not just “that won’t work.” I need to hear “and here’s what will work” Or here’s how we can get that done.” USAID has more field experience than any other agency. You have solved a lot of tough problems over the years, and I am asking you to please bring that expertise and creativity to bear on the problems that await us in the field.

Second, I need to know what needs to be fixed in order to carry out our mandates. Here are two examples:

Example one: This initiative will be held to a very high level of accountability and will be subject to constant scrutiny. To be accountable and to endure the scrutiny, the internal systems of all USG partners will need to be able to provide uniform and timely reporting. I need to be able to tell the President “here’s what we spent and what we got for it.” How do we, pulling together, get USAID up to the task? What can I do to help?

Example two: Some of you are part of the President’s Mother and Child Initiative. It is an unprecedented collaboration between multiple government agencies in Washington and in the field. How did that work? And how can those processes be improved?

The third part of our conversation is to discuss what I will be expecting of USAID. I recognize that the rules of the game have changed and change is always difficult and sometimes very distressing. I don’t intend to add to that distress by making you guess what the new rules are; too often organizations waste a lot of time and money trying to prepare for things that might be asked of them. I promise you that I will be clear about my expectations so that you can be effective, efficient, and successful. My aim is to establish management structures and procedures that are efficient and practical. I do not plan to create a large new bureaucracy. This brings me to one final observation which has to do with what is at stake with this initiative.

The President's Emergency Plan for AIDS Relief is historic. The President and Congress have committed a huge increase in international assistance that perhaps is not unprecedented but is certainly rare. No one can promise that if this effort is successful, funding for other sectors will open up. But what I can confidently predict is that if this initiative is a failure or is perceived to have failed, the climate for foreign assistance will suffer immensely. For the sake of all of the sectors you work in, this effort must succeed.
The good news is that we will succeed. This government has an amazing depth of talent, experience, and wherewithal. This is a chance to show the world what a great nation can do.

So in summary we are embarked together on an exciting mission to not only reach Presidential goals, but to also reach individuals who are counting on us to deliver the hope that was promised. My mission is to work with you and other partners -- inside and outside of the government -- to set a clear vision and a road map of where we are going over the coming years. With everyone pulling together we will get there. Thank you very much for this opportunity to begin the dialogue. And now, I will be happy to take a few questions.